Diabetes

Why do I need to poke my finger all the time to check my blood sugar?

Diabetes is best managed by the person with the disease. Physicians, dietitians, and diabetes educators can be useful resources but our primary goal is to give you the tools you need to make decisions and manage your disease on a daily basis. Blood sugar monitoring is a useful tool that helps you know how your current diabetes plan is working and helps you make choices about food, exercise and medication. It’s kind of like managing a business without financial statements, work schedules and sales figures. It would be difficult to know if you were succeeding without data to evaluate. You may get encouragement from seeing your blood sugars slowly go down after you begin an exercise program, or you may see one high blood sugar after you had a heavy meal of pizza and birthday cake. This daily information is invaluable to living a healthy life with diabetes.

How does my doctor seem to know how I’ve been doing for the last few months, even if I don’t bring in my blood glucose log?

If your doctor has ordered lab work for you, it probably included something called HbA1c or a glycosylated hemoglobin. This test accurately reflects the previous 2-3 months of your overall blood sugar control. It’s a good reflection of your daily blood sugar values, and can predict your risk of developing chronic diabetes complications. It should be measured routinely in patients with diabetes, or every 3 to 6 months. An approximate comparison of blood glucose and HbA1c values would be as follows: 5% HbA1c = 90 mg/dl; 7% HbA1c = 150 mg/dl; 9% HbA1c = 210 mg/dl; 11% HbA1c = 270 mg/dl.

What other tests are important besides blood glucose and HbA1c?

Your blood pressure should be checked and a visual inspection of your feet should be completed at every office visit. Your blood pressure target is below 130/80. A lipid panel should be evaluated at least once a year, and will include a measurement of your total cholesterol, triglycerides and LDL and HDL cholesterols. Your physician should also check your kidney function through blood or urine tests. It's recommended to have an annual eye exam by an ophthalmologist or optometrist that has experience with diabetic eye disease. You should also have a more complete foot exam annually that includes tests of your nerve sensation and feeling.

What should my blood sugars be? And, what’s normal?

Blood Glucose Goals in Nonpregnant Patients

Normal

Goal

Take action if…

Fasting glucose (before eating)

<110 mg/dL

80-120 mg/dL

<80 or >140 mg/dL

2-hours after eating

<140 mg/dL

<180 mg/dL

>180 mg/dL

Bedtime

<120 mg/dL

100-140 mg/dL

<100 or >160 mg/dL

HbA1c

<6%

<7%

>8%

* Plasma blood values are estimated to be 10-12% higher than whole blood values.
Be sure to check your meter to see which type it is.

How long does it take for changes in my diet and lifestyle to show up in my blood sugars?

Changes in your exercise and meal choices can show up immediately in your blood sugar values. Blood sugar is not a fixed number – it fluctuates over the day, but generally stays within an established range. It is extremely responsive to small changes. For instance, if you normally have a can of regular pop with your lunch and you switch to diet pop, you might notice a lower blood sugar following that meal on the first day you make the change. Or, if you go for a walk, you might see your blood sugar drop gradually afterwards from it’s pre-walk value. HbA1c will generally reflect changes in 1-2 months. If diet and lifestyle changes don't help you meet your lipid and blood glucose goals after about 3 months, it's a good idea to check with your physician to discuss your options.

It’s frustrating, because I can eat the same thing 2 days for breakfast and one day my pre-lunch value is just fine, and the next day it is too high. It seems like my blood sugar does whatever it likes no matter what choices I make.

It’s true that the most likely explanation for a change in blood sugar is a food choice. However, illness and stress can also push your blood sugar higher than normal. Be sure to consider all possible influences on blood sugar, besides just food. Remember, too, that sometimes blood sugar is affected by things we can’t control. A high or low blood sugar is not always your fault and an expectation that your blood sugars will be perfect every time is not realistic. Give yourself some room for variation without feeling like you’ve failed.